Today was an exciting day. While most days here in Peace Corps Nicaragua are relatively uneventful, with plenty of time for reading, chatting with neighbors and sleeping, today was a little more action-packed. One could even say… dangerous??
I accompanied a group of three nurses and a doctor out to a nearby small village which is part of my town´s municipality. I wasn´t sure exactly why we were going – they just told me that we were going to see a few patients. I didn´t have anything planned that morning, so I decided to tag along. As we rode along in the ambulance, speeding down the Pan-American Highway, I noticed that one of the nurses had some posters which contained information about Tuberculosis (TB). ¨What are those for? ¨ I asked. ¨Oh, I´m just going to give a talk about TB to the people there…¨ she said absentmindedly.
I came to find out, as we got to the community and started hiking up the mountains to where the houses were located, that we were doing a home visit to a family that had had a positive TB case. The patient, an older man was currently in the hospital, but had had contact with people in the house before he was admitted. ¨Oh great, ¨ I thought to myself, ¨Infectious disease, here I come.¨ We carried no gloves, masks, hand-sanitizer… just a few plastic jars to take saliva samples and the wordy Nicaraguan Ministry of Health official guidelines on Tuberculosis.
After walking in the 95F humid weather for a good half hour, we reached the house. Despite the desired shade that the living room provided, we entered a bit cautiously. I could almost hear the others holding in their breath, or was it my imagination? We looked critically around the house, as if searching for the TB germs that would suddenly go floating by, like the large flies we were constantly swatting away. We were met by an older couple- the TB patient´s parents. They were the only ones who lived in the house, but of course there were neighbors and small children constantly filtering in and out as well. We began our interview, asking when the patient´s symptoms started, where he lived, who slept in the room with him, who had had contact with him after he started becoming sick… Writing down all the details in chronological order was a difficult and long process. The information did not come easily. The older couple got confused, kept changing the dates, left out important details. The TB patient, who lived in another town by himself, had come to his parent´s house when his symptoms started. He lost his appetite, was tired, had a fever, night sweats, and a strong cough accompanied by a clear liquid. They had cared for him for four days in the house, everyone sleeping the same room.
Tuberculosis is a infectious disease that spreads through saliva (through talking, coughing, sneezing...) The chance of being infected is increased in poor countries like Nicaragua, where sanitation is substandard and many people live under one roof and sleep in the same room.
As the interview progressed, I found myself taking part in it as well- asking questions, and giving general information to the older couple on what TB was, how it was spread and how it was treated. I was pretty surprised that the doctors and the nurses let me do this – in fact, they seemed relieved that I stepped in and explained some of it, since it had been a while since some of them had brushed up their TB trivia. Not that I do either. Most of my limited knowledge about TB comes from the book I recently read, Mountains Beyond Mountains by Paul Farmer (a great read about public health in Haiti, Russia and Peru), or from reading the pamphlets and small booklets about TB that I´ve seen here while in Nicaragua. Needless to say, I´m no expert, but this older couple really listened to my advice, as simple as it may have been. Maybe it´s because I´m from the United States and look different from them. Maybe they thought I was a doctor… In any case, I´m glad I was there, because through some of my probing questions, we found out that there were actually young neighbor children the man had had contact with that could also possibly be infected. This information was not immediately given, and I had to dig for it. We ended up taking saliva samples from those children as well as the older couple.
After we had talked to everyone that had contact with the TB patient, we started to return to the ambulance to head back to town. At this point, the second exciting event of the day occurred. This community we visited was right along the Pan-American Highway which runs from North America to South America, cutting Nicaragua in half. My municipality is located in the north of the country, right on the border with Honduras. If you have been watching the news lately, you may have seen that in Honduras in late June, a military coup overtook and kicked-out (literally, out of the country) the President, Manuel Zelaya. Zelaya is a leftist leader and ally to the Nicaraguan President Daniel Ortega, Venezuela´s Hugo Chavez and Cuba´s Fidel Castro. Zelaya has been unable to re-enter his country since the coup, his plane not being allowed to land on Honduran soil. I saw on the news yesterday and was alerted by Peace Corps Nicaragua safety and security staff that Zelaya was planning a land-invasion of his own country via Nicaragua. Specifically, he was planning on undertaking a forced entry of Honduras at the border crossing which is about an hour north of my community by car.
As we walked towards the ambulance, suddenly a caravan of police cars and large pick-up trucks filled with people – some of them with television cameras, others with guns – flew by, headed north on the Pan-American towards the border. They were about 20 vehicles in total. This was obviously the Zelaya caravan – apparently he had announced that that morning around that hour that we happened to be walking along the highway, he would be heading to the border. A few minutes later, large trucks filled with Nicaraguan soldiers also sped by, heading in the same direction. Were they sent by the Nicaraguan President, heading up to be support staff of the Zelaya group? Or to calm the riot that was sure to ensue? ¨Those men are going into a war¨ commented one of the nurses about the caravan. ¨That Zelaya is crazy to do this.¨ Reports from the Honduras side inform that hundreds of Zelaya supporters have moved to the border area to meet the ex-president and protect his re-entry from the military. The government “de facto”, gave the military and the police force the order to apprehend Zelaya if he crosses into Honduran territory.
A shiver ran down my back. I wondered what would happen in the coming hours at that border. I knew the place they would try to cross – I had recently bee there helping with the Human Influenza border checks. The crossing was a relatively small area with a dilapidated customs building and a pathetic duty-free store (blenders, irons, towels…yeah, that´s about it). Many Honduran and Nicaraguan citizens cross each day to work on the other side, to visit family and friends, and do their shopping. Was this the place where we would possibly see a military stand-off? Would people be hurt?
I´ll have to check the news tomorrow online (probably when I´m posting this blog) since the local available news here on the radio and TV is highly biased and un-reliable. Only time will tell whether Zelaya will return to power or if the coup will keep holding him off. Apparently, one of the motives for the coup was Zelaya´s recent desire to pass a law which removed term limits on his presidency. On a similar note, the Nicaraguan President Daniel Ortega last week declared this was his desire as well. Hmm.
So, since my morning included both a communicable disease and a military coup, today is a little more eventful than most that I´ve had here. I mean, the most exciting thing that happened to me in the past week was the fact that the local cyber café got a new fan installed (so I won´t boil to death when I´m getting my internet fix), oh- and the fact that the little store on my street started selling Diet Coke. Yes, I live on the dangerous side here in Peace Corps.